Email question@potomacpediatrics.com a blank PDF copy and we will review the form you’ve submitted. If there is a high enough patient demand we will build an online version within 14 days for future automatic submission. We thank you for submitting blank copies to our office, and ask that you still submit your non-electronic forms using the cover sheet and form submission option below. Please note, we will not be building out private school forms that are replicas of Maryland State Forms.

Health forms not available on our website through automatic submission may be submitted by completing the cover sheet below and attaching your forms. Please ensure the parent section is completed prior to submitting your forms. Failure to complete the cover sheet and/or parent section will result in your forms being rejected.

Follow these easy steps HERE

Immunization records are attached to all health forms and have a Potomac Pediatrics stamp. Due to the nature of this process, we do not “sign” the form but the stamp constitutes an official record.

Please note that all forms may take up to 7 business days to be completed. We receive the highest volume of health forms April-August, resulting in completion times that may take the full 7 days. Forms are completed as they are submitted. There is no fast-track or expedited process for late submissions.